Endométriose pariétale:A propos de huit cas et revue de littérature

Introduction: Abdominal wall endometriosis is a rare and not well-recognized clinical entity. The diagnostic of this disease is difficult because of the non specific symptoms and absence of the performance of complementary exams. The diagnostic difficulty encouraged us to overlook this thesis work. Objectives: Our study aims to describe the epidemiological etiopathogenic, clinical and paraclinical characteristics of abdominal wall endometriosis; also to describe the different therapeutic methods and theirs indications and to conclude about the ways of prevention of this pathology. Materials and Methods: It is a retrospective study involving eight patients hospitalized at the Surgical Service of the University Hospital Fattouma Bourguiba Monastir, who had been diagnosed with abdominal wall endometriosis after histological confirmation during the period extending from January 2000 to January 2014. Results: We present seven cases of endometriosis developing in the abdominal wall following a Pfannenstiel cesarean section. Just one case concerned a spontaneous umbilical endometriosis. The interval between prior surgical procedure and the onset of symptoms ranged from 2 to 12 years, for a mean of 4,3 years. Only three cases had typical presentation with cyclic pain. Seven patients had an abdominal ultrasound examination in first intention. Magnetic resonance imaging, obtained in two patients, was helpful and suggested the diagnostic in those two cases. In just three patients, the diagnostic of abdominal wall endometriosis was suspected preoperatively. A complete surgical resection was realized in every case. The diagnostic was definitively confirmed by the pathological examination of the resected specimen in all the cases. All the cases had regular follow-up ranging from 2 months to 11 years and there were no recurrences in any patient. Conclusion: Following this work, we can conclude that every physician should maintain a high level of suspicion of abdominal wall endometriosis for any woman in reproductive age presenting with a mass at the abdominal wall. The complementary exams may be of use to confirm the diagnostic. The histological examination is necessary for the diagnostic and the treatment of choice is wide local excision with negative margins, to prevent recurrence; especially since rare cases of malignant transformation of abdominal wall endometriosis were described in the literature.